BTS Best Practice Conference Awards

Testimonials from the ERS 2017 conference

Tuesday, January 2, 2018

We've heard from recipients of the BTS Best Practice Conference Awards about what they learnt at the European Respiratory Society conference 2017, how they shared their experience with their teams, and how such learnings could affect patient care.

Luke Daines, GP and PhD clinical fellow, University of Edinburgh

For me, ERS 2017 began with the primary care day on Saturday 9th September which offered a rich programme. Multidisciplinary team-working for the community management of chronic diseases was advocated by Jaime Correia De Sousa and further emphasised by Antonio Caviglia who explained how in his country, respiratory care remained largely specialist-led, with general practitioners used mostly to implement the management plan received. These talks made me realise the benefits of working within the NHS where primary care is generally well valued. However, later discussions with other delegates made me wonder what could be done in my area to improve primary and secondary care integration: consultant led multi-disciplinary clinics in GP practices for instance? Consequently, I have arranged to spend time with my local community respiratory team and attend respiratory department meetings to understand more about what they do and how we could work together better.

Self-management

I presented qualitative research on patients views of self-management in asthma. My results were corroborated by other groups: patients prefer tailored self-management, considerate of their language and culture and providing opportunity for their personal needs to be discussed. Within the university setting, I was able to share these messages via social media, and during a monthly research meeting. Through an NIHR programme grant, the improved implementation of self-management in routine general practice (IMP2ART study) will be investigated.

Dysfunctional breathing

One of the research highlights was the result of a randomised controlled trial reporting that a self-guided breathing retraining intervention delivered by DVD and booklet were effective in improving the quality of life of adults with incompletely controlled asthma. I’ve often struggled to know how to help patients with dysfunctional breathing and needed to refer to secondary care to access specialist physiotherapy. This intervention will provide an effective way to help patients overcome the difficulties of dysfunctional breathing, I’m looking forward to using it.

Asthma diagnosis

My congress highlight was the chance to hear from Shawn Aaron, the lead author of a study that re-evaluated patients diagnosed with asthma in the community. The study reported that after comprehensive testing, no features of current asthma were found in 33% of patients previously labelled with asthma. Having recently started a PhD considering ways of improving the accuracy of asthma diagnosis in primary care, it was extremely helpful to discuss the topic with leading experts. Over-diagnosis leads to costly and potentially harmful treatment as well as unnecessary healthcare use. My university work provides me with many opportunities to discuss asthma diagnosis with other professionals both informally and at meetings. Translation of this area to patients has been both immediate and long term. In the short-term I have been able to adapt my clinical practice becoming more rigorous in my approach to diagnosing asthma. In the future, I hope my research will contribute to greater accuracy of asthma diagnosis in primary care which will benefit patients by reducing mis-diagnosis.

Dr James Brown, Royal Free NHS Foundation Trust, London

With the generous support from the British Thoracic Society conference awards I was able to attend the ERS 2017 Congress in Milan, and also the TB NET meeting which preceded the ERS.

This gave me the opportunity to present results of our research regarding lung disease in people living with HIV: I presented a poster describing the results of our work evaluating the prevalence of unexplained breathlessness in this population. As well as disseminating the results of this work this was a valuable opportunity to get constructive feedback from the experts chairing the poster presentation session.

In addition to giving the chance to present our own research, the ERS Congress provided the opportunity to attend lectures and seminars given by leading researchers in their fields. Particular highlights of a very packed schedule included a symposium on the clinical impact of nontuberculous mycobacterial disease addressed by leading experts including Jakko van Ingen, Timothy Aksamit and Michael Loebinger; a lunchtime session regarding diagnosis, pathogenesis and management of hypersensitivity pneumonitis and the Lancet commission on asthma, which provided a highly stimulating and challenging new perspective on the diagnosis and management of asthma.

The ERS congress provided the opportunity to present work and learn from leading experts, but also to meet with colleagues and collaborators and make new connections. I returned to the UK with renewed inspiration and ideas for future research.

Dr Helen Molloy, St James’s University Hospital Leeds

The ERS conference was the first conference that I had attended and it was a great learning experience. I went in order to present some research that I had carried out whilst at medical school. This was the first piece of research that I had presented and was a very positive experience. The research was based on the use on non-invasive ventilation and after I had spoken about the research I was approached by other medical staff as well as representatives from some of the companies that provide the equipment. This allowed me to gain information from people working in other hospital about their experiences with using non-invasive ventilation but also from the companies. This was added to by the fact that I was able to speak to a variety of different professionals in the exhibition about the equipment and improvements that could be made based on what we had found from the research. After the conference, I was able to feed this information back to the team in Leeds with whom I had carried out the research. Knowledge of different options available for our patients means that going forward we have the necessary information in order to provide the best care for our patients.

As well as presenting my research the conference also gave me the opportunity to attend lectures and teaching sessions and further my learning. I chose a variety of lectures to attend some of which were based on things that I thought would be useful for my current job in elderly care and some which I thought would be useful going forward in my career.

I attended a lecture about end of life care for respiratory patients which I found particularly useful. Many of my patients come to the end of their life whilst with us and many of them have respiratory co-morbidities. The knowledge that I gained will help me to ensure that the best care is provided to them at the end of their lives. I am also arranging to pass this information on to my colleagues by doing some teaching with the other members of staff on the ward that I work on.

Also for personal interest and due to the fact that I would like to pursue a career in paediatrics I attended some lectures based on paediatric respiratory care. This will be useful for me going forward as I gained new knowledge that will help make my practice better in the future.

I would like to thank you and the British Thoracic Society for supporting my attendance at this year’s European Respiratory Society conference. I am currently a Band 7 Physiotherapist specialising in Pulmonary Rehabilitation. Attending this year’s conference has been very special for me and my team as I was chosen to present my abstract in the ‘Best abstracts for Pulmonary Rehabilitation’.

During my time at this year’s conference I found some interesting pieces of research that may appeal to the British thoracic society’s members:

One of them was Identification of Phenotypes in people with COPD and their influence of physical activity in daily life, body composition and skeletal muscle strength.

They investigated the phenotypes in patients with COPD according to physical activity, sedentary behaviour, body composition and muscle strength. And to investigate the characteristics of patients according to each identified phenotype.

As always, ERS provided an excellent variety of interesting educational events, networking opportunities and access to new technology ‘toys’.

With my specialty certification exam looming on my return, this congress I made use of the varied Grand Round sessions. One particular session stood out – a grand round on occupational lung diseases.

In my current role, I am participating in frequent asthma clinics. As an element of these we regularly review patients with, or at risk of occupational asthma. I found the session eye opening, with new presentations of occupational disease of which I had not previously been aware. I fed back on the sessions to my colleagues who also work in asthma clinic, with particular interest about conditions presenting with a sarcoidosis-like granulomatous disease. The session also sparked an interesting debate about the ethics of referring and diagnosing occupational lung diseases, particularly regarding one particular case where the medical team were directly employed by a mining company. This lead to an evident conflict which the presenting medic acknowledged, but that we as a group of colleagues found a fascinating topic to mull over.

Thank you to the BTS for support in attending this event to present my work and to learn from international experts.

I would like to sincerely thank you and the British Thoracic Society for supporting my attendance at this year’s ERS conference. I am in the final year of my PhD and it allowed me to disseminate some of my study results, which were well received, and learn about emerging research topics in lung fibrosis that may guide my future research career.

I would like to highlight some pieces of research that I found interesting and may appeal to the society’s members:

An Australian research group undertook a multi-centre randomised controlled trial investigating the benefit of using ambulatory oxygen compared to medical air during the exercise component of pulmonary rehabilitation in 97 COPD patients who desaturated with exercise (Alison et al., 2017). Although both groups improved following pulmonary rehabilitation, the authors reported no significant between group difference in exercise capacity and quality of life. They concluded that training with supplementary oxygen did not provide additional benefit compared to room air. This was an interesting abstract with potential implications for pulmonary rehabilitation services, although more research is required.

A randomised controlled trial, undertaken in Germany, investigated the effects of performing squat exercises on a whole body vibration plate to the same exercises on the floor in 70 patients following lung transplantation and a three week pulmonary rehabilitation programme (Gloeckl et al., 2017). The authors reported that after one year, the patients who exercised on the vibration plate showed significantly greater improvements in the six minute walk test distance and peak cycling work rate compared to those who exercised on the floor. Whole body vibration is a novel concept in chronic respiratory disease and may be useful adjunct to exercise training.

A hot topic at this year’s conference was home-based pulmonary rehabilitation; however, the data presented was conflicting. For COPD patients, outpatient pulmonary rehabilitation improved exercise capacity more than lightly-supervised home-based pulmonary rehabilitation, but changes in health status are similar (Kaliaraju et al., 2017). In contrast, a home-based programme for people with bronchiectasis improved functional capacity, quality of life and muscle strength (Corso et al., 2017). Another research group found that home-based pulmonary rehabilitation for very breathless COPD patients (MRC grade 5) reduced hospital admissions over six months but did not reduce Accident and Emergency visits. Home-based pulmonary rehabilitation is an emerging area of interest and we await further studies to confirm its role in the management of patients with chronic respiratory disease.

Thank you again for the opportunity to attend ERS 2017.

Rahul Shrimanker, Respiratory Medicine Unit, NDMRB, Oxford

Thank you for the travel award which enabled me to attend the European Respiratory Society congress in Milan this year. I was able to present some of my work focusing on the nature of asthma attacks on mepolizumab treatment which I have produced as part of my PhD in severe asthma .

Attending the meeting allowed me to evaluate some of the most recent research in my area of interest, meet and talk to expert colleagues in the field and also discuss research areas with fellow researchers and clinicians.

Some highlights include

presentation of the data for tezepelumab1, a new monoclonal antibody therapy against thymic stromal lymphopoietin (TSLP) for asthma. This treatment seems to work across a number of phenotypes of asthma, not just the eosinophilic group who have a number of newer treatment options, and offers hope to a group of patient with non-eosinophlilic asthma who are desperately in need of better treatments.

Presentation of the data for mepolizumab in chronic obstructive pulmonary disease (COPD)2. This trial suggests a role for mepolizumab in eosinophilic COPD, a condition which has a very limited number of treatment options for persistent exacerbations currently other than long term oral steroids which have associated morbidity.

Attending the presentation and discussion on the Lancet Commission on Asthma3 – this document attempts to change the direction of travel in asthma diagnosis and treatment, focusing on identifying treatable traits in patients guided by biomarkers and aims to dispense with disease labels which do not further treatment care. There was stimulating discussion between the authors and the audience which I was able to contribute to.

Attending the Early Career Researcher meeting – a chance to meet fellow researchers who are studying various aspects of respiratory disease. This gave a good insight in to the various approaches, research set-ups and opportunities available.

Presenting my two posters – stimulating discussion with the moderators and interested congress attendees. Some useful ideas and potential collaborations for future work.

This meeting has helped inform my practice in the severe asthma clinic, especially where there are current gaps in the guidelines and knowledge, and to keep patients up to date with regards to upcoming treatments which may be of interest to them. It has helped shape my current research ideas and will be of huge use in the final write-up.

I have presented a summary of my ERS learning points to the local respiratory registrars and my research department. I am due to give a highlight of some of the key papers presented at the ERS at a regional training day.

I would like to sincerely thank you and the British Thoracic Society for supporting my attendance at this year’s European Respiratory Society conference. I am currently a Band 6 Physiotherapist specialising in Pulmonary Rehabilitation and Respiratory Outpatients. Attending this year’s conference gave me the prestigious opportunity to present my first research abstract as an oral presentation in the ‘Best abstracts in Rehab and Chronic Care’ session. This experience has inspired me to pursue a future career in research and start a Master’s degree to further my research experience in the rehabilitation in patients with chronic respiratory disease.

During my time at this year’s conference I found some interesting pieces of research which I have shared with my colleagues that may appeal to the British Thoracic Society’s members:

The response to pulmonary rehabilitation in COPD patients has been widely investigated however the response of other chronic respiratory diseases, such as bronchiectasis, is less well known. Some pieces of research on this topic were presented at the conference. Kumar and colleagues (ERS 2017) undertook a randomised control investigating the response of bronchiectatic patients to pulmonary rehabilitation. The intervention demonstrated an improvement in exercise capacity and health related quality of life therefore suggesting that pulmonary rehabilitation should be considered in the management of these patients.

This topic is a personal interest of mine. In a retrospective, observational, propensity score matched analysis I found that pulmonary rehabilitation improved exercise capacity and health related quality of life in bronchiectatic patients compared to a matched group of COPD patients. However, we showed that the fatigue domain of the Chronic Respiratory Questionnaire (a measure of health-related quality of life) was less responsive in the bronchiectatic group compared to the COPD group. The reason for this is unknown and is important to explore further into this to ensure that the best support is available to patients with bronchiectasis referred to pulmonary rehabilitation.

Another interesting study was a preliminary report of a study investigating the effects of neuromuscular electrical stimulation (NMES) on functional exercise capacity, respiratory and peripheral muscle strength in patients with interstitial lung disease. Twenty-six patients were recruited to this double-blind, randomised control double trial. The authors reported that the use of NMES showed to have made an improvement in exercise capacity in the intervention group. This is an interesting study however further research is needed to support the use of NMES in clinical practice as an effective adjunct to pulmonary rehabilitation.

Thank you once again for the opportunity to attend ERS 2017. Please do not hesitate to contact me if I can contribute to the British Thoracic Society in any way in the future.

Dr Lilia Dimitrov, Royal London Hospital

This was my first time attending the European Respiratory Society International Congress. I presented a poster in the discussion session “Risk factors: symptomatology and diagnostic approaches for obstructive sleep apnoea”. The poster was entitled “Validation of ASA scoring algorithm for perioperative risk of complications from OSA” and it detailed the results from our retrospective cohort study that looked to validate the American Society of Anesthesologist’s (ASA) perioperative risk score for OSA. There has been considerable interest into the use of screening questionnaires for the diagnosis of OSA, with a number of new tools developed over the last decade. Increasingly, the use of these screening tools has broadened to include the identification of individuals at high risk from OSA-related perioperative complications. In their updated 2014 guidelines, the ASA Taskforce developed a perioperative complication screening tool that categorises patient into low, medium and high risk based on their OSA severity, type of surgical intervention and use of post-operative opioids. The implication of this, is that patients can be pre-operatively identified as at risk of perioperative or postoperative complications and adjustments made to avoid these complications such as elective HDU post-operative care, use of pre-operative CPAP and controlled use of opioids in the post-operative period.

This was my first opportunity to present the work we had done to an audience and I was eager to see how it would be received. Prof Walter McNicholas, chair of the session, offered some very useful feedback. He was keen to find out “will this study change practice?” All researchers want the output of their work to inform current clinical practice but due to the vast complexity of factors involved, this unsurprisingly only occurs for a small proportion. I was not able to answer fully yes to this question but I believe our study has made a small but relevant contribution to the field of screening tools in OSA. Our study is, to the best of our knowledge, the first to clinically validate the ASA perioperative risk tool. Our findings were in keeping with other tools, with a reasonable sensitivity of 65.9% and modest specificity of 48.8%. This suggests that there is some utility in applying this tool to patients seen in the pre-assessment clinic prior to surgery but that it should be used with caution.

Our study was not without limitations with a small sample size, small numbers of documented complications and generally mild severity of OSA. Some of these issues were raised by the audience in the session and were important and interesting points of debate. These discussions have directly contributed to the final manuscript which has now been written in preparation for submission. Collaboration is an important strategy for generating new ideas or interpretations and we believe our research will be stronger now having had this opportunity to present our findings and learn from our international colleagues. We have already shared our experiences with our team through discussion at a local meeting and will circulate the paper once published.

Many thanks for supporting me with a travel grant to the European Society Congress in Milan. The conference was especially valuable for my clinical and research training in respiratory medicine.

One of the opening sessions I attended was ‘Pleural disease and mesothelioma’. I presented my own work on biomarkers in mesothelioma but was very interested in some of the novel research on malignant effusion biomarkers and translational science in mesothelioma. Dr Kumar presented some fascinating work on the impact of BAP1 expression in mesothelioma. Much of my work has been on better prognosticating this malignancy to better select patients for treatment so her findings were especially pertinent. Additionally, some state of the art translational research from Ioannis Psallidas on prognostic and therapeutic biomarkers will doubtless lead to more patient centered treatment in the future.

Perhaps one of the stand-out sessions from the conference was a Lung Cancer Grand Round in the main auditorium. A series of excellent speakers on issues of real uncertainty within lung cancer management has already improved my day to day practice. Matthew Everson delivered a talk on curative treatments for ‘unfit’ patients- demonstrating the impact of CPET testing and pulmonary rehabilitation using real-life scenarios. A presentation on personalised treatment for lung adenocarcinoma using immunotherapy opened my eyes as to the options that will be available to us in the future, and the challenges that come with them. On a light hearted note the Respiratory Championship was very entertaining and hopefully will be an ongoing part of the Congress in the future. The ERS Young Scientist Networking Evening was an opportunity to meet other respiratory physicians and researchers at an early stage of their careers to share experiences and ideas about the Congress and future research.

Finally, one of the last sessions of the congress was one on RCTs in the management of malignant pleural effusions. The 4 speakers presented the latest evidence on the investigation and management of malignant effusions. Some of the research was very exciting and practice changing including Naj Rahman’s work on debunking myths of pleural disease and Rahul Bhatnagar’s study of talc pleurodesis using indwelling pleural catheters.

In all I found the Congress a wonderful opportunity to keep abreast of the latest developments in respiratory medicine to improve patient care, disseminate my own research findings, and meet like-minded researchers. Again, I would like to thank the BTS for giving me these opportunities by supporting my attendance at this conference.

Dr Giulia Spoletini, Leeds Regional Adult Cystic Fibrosis Centre

The 27th ERS International Congress took place in Milan and I was lucky enough to be awarded a BTS travel fellowship to attend the conference in full.

The conference was an exceptional learning opportunity for me as well as being a great outlet to present my research work.

The major learning points I have taken from the Congress were:

How to approach and manage patients with end-stage lung disease and in end-of-life care pathway. A number of speakers and patients presented their experience in relation to this very delicate and important aspect of patients’ care, and this provided a very important reflection point for my clinical practice, which I believe improved my way of communicating with this category of patients.

The new ERS/ATS guidelines on non-invasive ventilation were presented. The process of developing these guidelines was also discussed which allowed me to reach a deeper understanding of the extensive guidelines document.

Several posters, oral presentations and symposia regarding NTM, their epidemiology and management in CF and non-CF patients, were presented. This was of particular interest for me as I worked on an audit on NTM in CF during the past year, and these presentations provided further insight and state-of-art updates on this infection, especially as some of the speakers at the symposia started presenting the new BTS guidelines.

More in general, however, all the sessions (oral presentation, poster, and symposia) I attended allowed me to reflect on how to improve my daily practice. I discussed what I learned and the main sessions I attended with my colleagues on my return, and I often still find myself mentioning and discussing what I learnt at the conference and how that could be of interest in relation to our practice or important for a specific patient.

In addition, I had the chance to present my own research on the treatment of dyspnea in DNI patients. This allowed for discussion with other attendees both in the allocated time for presentation, but also at the end of sessions. The feedback I received will help improve my clinical research skills.

In summary, the ERS International Congress was extremely useful for me as

it provided me with many reflection points on my daily practice;

it allowed me to gain new knowledge on clinical research methodology and how these concepts resulted in the development of new guidelines;

it provided me with new insight and knowledge on acute and chronic infections;

it gave me the chance to update myself in areas of respiratory medicine, that are far from my daily practice, such as lung cancer and ILD.

Thomas Moore, Stoke Mandeville Hospital

I am extremely grateful for the travel grant from the British Thoracic Society. This allowed me to travel to Milan to the European Respiratory Society conference and present the results of an audit titled- ‘The ambulatory management of pulmonary embolism in a district general hospital’. I prepared and delivered a 15 minute presentation to a group of 50-100 people with a similar theme.

What did I learn?

Learnt a lot more about my subject and have since had a number of occasions where I have been able to apply it in clinical practice both directly in my own practice and indirectly via teaching others.

Interacted with some key researchers in the field relating to risk stratification of pulmonary emboli.

Learnt about different aspects/updates in respiratory medicine. Some which stuck out include;

Learnt about novel diagnostics in pleural infection- by biopsing and culturing and performing quantitative polymerase chain reaction on sample of pleura- presented by Oxford Pleural team

Attended key teaching sessions on occupational lung diseases.

Made new contacts and will potentially be embarking on a new project via a UK doctor that I met.

How will it be shared with my team?

A number of my team (that helped with the project) travelled to the conference so I was able to reflect on the project on the whole and on my delivery. We discussed it in relation to new evidence and presentations seen at the conference.

The findings from the audit and feedback from the conference will be used to plan the next stage of the audit cycle and help us update guidelines

As above- will be able to use my expertise in this field with ongoing clinical encounters either individually or team based.

ERS 2017 was an excellent chance to both increase my knowledge and understanding but also to present my research to an international audience. I attended lectures and symposia that were specific to my own research (i.e. environmental pollutants/epidemiological characterisation of asthma and respiratory pharmacology), but also had the opportunity to broaden the depth of my knowledge in other parts of lung research that I was not previously familiar with. For example, in one session, I spoke to the presenter regarding their research into oxidative stress and its possible role in reducing lung function in children. Though this was not specific to my research in asthma, nor any environmental irritant, the tools and methods used, gave a good insight into how such mechanisms may be involved in the asthma symptoms such as cough and bronchospasm that I research.

In order to share my findings from the ERS with my team, I took detailed notes on the symposia I attended and took pictures of key posters to study later in detail. This was then kept in a shared folder, in which all of our group were able to browse through. The best thing about ERS was the ability to have so many world leaders in research present in one place and allow the exchange of ideas and research in a supportive environment.

As well as this, I was also able to receive feedback and new perspectives on my research from those present at my poster discussion session. This helped to tailor the key aspects of my research to present to both a clinical and non-clinical audience. Because of a discussion with the chair of my session, I was able to get new ideas on how to investigate mechanisms by which plastics by-products may contribute to asthma symptoms and activation of airway sensory nerves. This will hopefully lead to advances in my own research and give us a better understanding of how such environmental contaminants can trigger asthma symptoms.

Janina Mallari, Papworth Hospital NHS Trust

I have truly enjoyed my time at the ERS congress in Milan as it was my first time and I am grateful to have had the opportunity to present my abstract on Motor Neurone Disease and Lung Function testing. Throughout the congress, I have attended seminars, lectures and poster presentations.

These are the highlights from my experience:

During the congress, I have gained a deeper understanding on the pathophysiology and emerging therapies for severe asthma especially distinguishing poorly controlled asthma by clinical features. This will help my department in having a greater understanding of the disease and its severity and form (eosinophilic and non-eosinophilic), also allowing us to find ways to effectively managing patients with Asthma. Secondly, I have attended a Thematic Poster Presentation on diagnosis, assessment and management of COPD. This session allowed me to see and understand COPD is a broader way such regarding its prevalence, classification and how different treatment combinations have been proven to be more effective in reducing exacerbation and improving clinical outcomes in patients with COPD. By having a broader understanding of COPD allows us as health care professional to deliver good patient care with up-to-date evidence based research and knowledge.

My abstract presentation was included in the session titled “Discussion of techniques and technologies in lung function”. As a physiologist, this session was of interest and of benefit to me. During the discussions, I have learnt the importance of testing new brand of equipment and set ups to ensure that it has a good agreement with the other brand/set-ups of equipments. There were also new insights on on-going research on how we could quantify and record breathing parameters by tidal breathing in other ways such us using structured light plethysmography. This method might be considered for patients who struggle with technique lung function testing as well as patients who are unable to physically perform the manoeuvre (motor neurone disease patients). These new findings and methods will make the patient’s experience with lung function more positive leading to a good clinical practice.

My experiences and all that I have learnt were shared to my colleagues in one of our staff meeting, updating them of the new findings and research. This has helped us to gain a better understanding on the pathophysiology and management diseases such as Asthma and COPD therefore caring for patients more effectively and striving to always give patient the best experience during their visit in out department.

I would like to thank BTS for the grant and the opportunity to take part in the ERS Congress 2017.

BTS is grateful to GSK and Vertex Pharmaceuticals for providing funds to support this initiative. The companies are not involved in any way in setting the criteria for selection or the selection process itself.